RECONSIDERATION DECISION
Before:
Ulana Pahuta, Adjudicator
Licence Appeal Tribunal File Number:
23-015078/AABS
Case Name:
Jonathan Mazerolle v. Motor Vehicle Accident Claims Fund (MVACF)
Written Submissions by:
For the Applicant:
Roger R. Foisy, Counsel
Rusald Laloshi, Paralegal
For the Respondent:
Daniel Fenwick, Counsel
OVERVIEW
1On September 16, 2025, the applicant requested reconsideration of the Tribunal’s decision dated August 26, 2025 (“decision”).
2In this decision, the Tribunal found that the applicant was not entitled to the outstanding balances of five treatment plans in dispute. For all five treatment plans, the Tribunal found that the applicant was not entitled to denied administrative expenses relating to form completion, and for two of the treatment plans, the Tribunal found that the applicant was not entitled to denied transportation/mileage costs. The Tribunal also found that the applicant was not entitled to an award or interest in accordance with s. 51 of the Statutory Accident Benefits Schedule – Effective September 1, 2010 (including amendments effective June 1, 2016) (“Schedule”).
3The grounds for a request for reconsideration are found in Rule 18.2 of the Licence Appeal Tribunal Rules, 2023 (“Rules”). To grant a request for reconsideration, the Tribunal must be satisfied that one or more of the following criteria are met:
a) The Tribunal acted outside its jurisdiction or committed a material breach of procedural fairness;
b) The Tribunal made an error of law or fact such that the Tribunal would likely have reached a different result had the error not been made; or
c) There is evidence that was not before the Tribunal when rendering its decision, could not have been obtained previously by the party now seeking to introduce it, and would likely have affected the result.
4The applicant seeks reconsideration pursuant to Rule 18.2(b). He submits that the Tribunal erred in fact, law, and mixed fact and law when it denied transportation/mileage expenses incurred during rehabilitation support worker (“RSW”) sessions. The applicant further submits that the Tribunal erred in law and fact in refusing to grant an award under s. 10 of Regulation 664. The applicant does not appear to be disputing the Tribunal’s findings with respect to the administrative expenses relating to form completion.
5The respondent submits that the Tribunal did not commit any error in law, fact, or mixed fact and law. The respondent argues that the applicant is asking the Tribunal to re-weigh matters already determined, and requests that the reconsideration request be dismissed.
RESULT
6The applicant’s request pursuant to Rule 18.2(b) is granted.
7Pursuant to Rule 18.4, I have ordered a re-hearing of the issues of denied transportation/mileage costs, interest and an award.
8Upon re-hearing the issues, I have determined that the applicant is entitled to the denied transportation/mileage costs in the treatment plans dated December 6, 2021 and July 12, 2022, plus interest. The Tribunal’s finding that the applicant is not entitled to a s. 10 award, is confirmed.
ANALYSIS
9The test for reconsideration under Rule 18.2 involves a high threshold. The reconsideration process is not an opportunity for a party to re-litigate its position where it disagrees with the Tribunal’s decision, or with the weight assigned to the evidence. The requestor must show how or why the decision falls into one of the categories in Rule 18.2.
Grounds for reconsideration – Rule 18.2(b)
10In this case, I find that the applicant has established grounds for reconsideration pursuant to Rule 18.2(b).
11The test in Rule 18.2(b), as set out above, has two parts. The first part is that the Tribunal made an error of law or fact. The second part is that the error is such that the Tribunal would likely have reached a different result had the error not been made.
Mileage expenses
12With respect to the first part of the Rule 18.2(b) test, I find that the Tribunal erred in its consideration of provider mileage expenses in the amount of $720.00 with respect to two treatment plans dated December 6, 2021 and July 12, 2022 ($1,440.00 total).
13The applicant submits that the Tribunal erred in its application of the Superintendent's Guideline No. 04/16: Transportation Expense Guideline (“TEG”), and the Financial Services Commission of Ontario (“FSCO”) bulletin on travel expenses. He argues that in his hearing submissions, he clearly stated that the disputed transportation charges were not for a provider commuting to or from a claimant. Rather, they were for mileage that was incurred during his RSW treatment sessions, where the RSW used their car to transport the applicant to therapeutic and community-integration tasks. The applicant argues that his hearing submissions and evidence advanced the position that in-session transportation of the insured in the RSW’s vehicle qualifies as an authorized transportation expense under the TEG.
14In his reconsideration request, the applicant submits that while the Tribunal acknowledged that the applicant advanced the argument that transportation during a treatment session within a provider’s vehicle should be covered, in its finding, the adjudicator misapprehended the record and based his findings on whether mileage related expenses were payable when a service provider is traveling to a client. The applicant also submits that the Tribunal erred in applying the TEG and FSCO bulletin to the facts, when it found at paras 15-22 that mileage-related expenses are not payable “when a service provider is traveling to a client”.
15The respondent argues that the adjudicator properly applied the TEG and FSCO’s bulletin to the facts of the case, and found that there is no provision for provider mileage and that paying a provider’s travel time during a session does not create entitlement to mileage as well.
16I find that the Tribunal did err in its application of the TEG and FSCO Bulletin to the facts of this case. In para 12 of the decision, the adjudicator accurately noted that the applicant had submitted that transportation “during a treatment session within the treatment provider’s vehicle should be covered since that includes transportation of the applicant and an aide”. However, in denying the mileage expenses, the adjudicator found at para 15 that “there is no provision in the legislation to provide mileage-related expenses when a service provider is traveling to a client”.
17In para 16, the adjudicator further noted that per the FSCO Bulletin, even though the applicant may be in the vehicle during community excursions, insurers are not required to pay for mileage expenses “even in circumstances where the insurer is paying for the provider’s travel time”. However, I agree with the applicant that this provision of the FSCO bulletin expressly states that this exclusion for payment of mileage only relates to the “transportation of anyone other than the insured person (and aide or attendant), if any”. In this case, the matter did relate to the transportation of the insured person.
18Therefore, the Tribunal did err in fact and law when it misstated the record and noted in its finding that mileage related expenses are not payable when the provider is travelling to a client. I further find that the Tribunal erred in law in its consideration of the FSCO bulletin. I find that both of these errors would likely have changed the outcome of the decision.
19Accordingly, the applicant has established grounds for reconsideration pursuant to Rule 18.2(b) with respect to mileage expenses.
Section 10 award
20I find that the applicant has established grounds for reconsideration pursuant to Rule 18.2(b) with respect to the s. 10 award.
21The applicant submits that in the decision, the Tribunal did not address the legal and factual submissions the applicant had made in his hearing submissions with respect to a s. 10 award. It did not address the numerous examples of the respondent’s unreasonable withholding or delay, but simply noted that the respondent’s behaviour was “frustrating” and that “the confusion over policy limits…should have been avoided”. However, the applicant argues that the adjudicator did not engage with the submissions or evidence or consider the legal test for an award, to determine if the evidence supported the applicant’s or the respondent’s position.
22The respondent submits that the adjudicator properly considered whether payment of benefits was unreasonably withheld or delayed, and found that frustration or administrative missteps do not suffice. Accordingly, there was no legal or factual error with respect to the Tribunal’s finding that the applicant was not entitled to a s. 10 award.
23I find that the Tribunal erred in its analysis of whether the applicant was entitled to a s. 10 award. The finding at paras 32-33 that no benefits were unreasonably withheld or delayed is conclusory, without reasons. In his submissions for the hearing, the applicant provided detailed submissions with reference to evidence to argue that the respondent repeatedly denied treatment plans on the basis that the non-catastrophic funding limit of $65,000.00 had been met. However, in his hearing submissions he argued that the evidence clearly established that $22,564.13 remained in the funding limit. He also provided arguments with reference to evidence relating to late approvals of treatment plans and income replacement benefits.
24I agree with the applicant that the Tribunal erred in not engaging with the detailed submissions and evidence. I further find that the error is one that would likely have changed the outcome of the decision.
25Accordingly, the applicant’s request for reconsideration pursuant to Rule 18.2(b) is granted.
Outcome of reconsideration – Rule 18.4
26I now turn to the outcome of the reconsideration pursuant to Rule 18.4. Rule 18.4 provides that upon reconsidering a decision, the Tribunal may dismiss the request. Rule 18.4 also provides that after providing responding parties an opportunity to make submissions, the Tribunal may confirm, vary or cancel the decision; or order a rehearing on all or part of the matter.
27I find the applicant has established grounds for reconsideration pursuant to Rule 18.2(b). As such, I am ordering a rehearing of the issues of whether the applicant is entitled to the denied mileage expenses, interest and a s. 10 award pursuant to Rule 18.4.
Rehearing of the issue of mileage expenses and related interest
28As part of the reconsideration decision, I have conducted a rehearing of the applicant’s entitlement to mileage expenses in the treatment plans dated December 6, 2021 and July 12, 2022. In doing so, I have considered the parties’ evidence and submissions for the initial written hearing.
29Pursuant to s. 16(1) of the Schedule, rehabilitation benefits shall pay for all reasonable and necessary expenses incurred by or on behalf of an insured person in undertaking activities and measures described in subsection (3) that are reasonable and necessary for the purpose of reducing or eliminating the effects of any disability resulting from the impairment. Subsection (3) includes, (k) transportation for the insured person to and from counselling and training sessions. Subsection (4)(f) clarifies that an insurer is not liable to pay for transportation expenses other than “authorized transportation expenses”.
30The respondent did not dispute that the mileage expenses were reasonable and necessary. The clinical notes and records and invoices of the service provider confirmed that the travel was billed during the treatment sessions for activities such as visiting coffee shops, going for an outing to the shopping mall, driving to a park for a walk, or accompanying the applicant to hydrotherapy. I accept the applicant’s submissions that the proposed mileage expenses were reasonable and necessary. There was also no dispute that the applicant had been found to be catastrophically impaired.
31However, the respondent further argued that mileage expenses are captured in the administrative and overhead costs of the service provider and are not payable by an insurer. It cited both the FSCO bulletin and the TEG to argue that provider mileage is not an authorized transportation expense.
32When considering the Schedule, the TEG and the FSCO bulletin, I find that the $1,440.00 in mileage expenses are “authorized transportation expenses” and are payable by the respondent.
33As noted above, pursuant to s. 16(4)(f) of the Schedule, an insurer is not liable to pay for transportation expenses other than “authorized transportation expenses”. The respondent submitted that the FSCO bulletin is clear that provider mileage is not an “authorized transportation expense” under the Schedule and insurers are not required to pay for such expenses if claimed by a health care provider, even in circumstances where the insurer is paying for the provider’s travel time. However, I agree with the applicant that the FSCO bulletin limits this prohibition on payment of mileage expenses to mileage “related to the transportation of anyone other than the insured person”. In this case, the mileage did relate to the transportation of the insured person.
34The TEG further clarifies transportation expenses, and states that an insurer is liable to pay a mileage expense for transportation of the insured person and his aide to and from treatment sessions, counselling sessions, assessments and examinations, using the insured person’s automobile. An “insured person’s automobile”, as defined in the TEG, includes any automobile that is owned or leased by the insured person, or any other automobile that the insured person has access to. The applicant submitted that he does not have a driver’s license or a vehicle, nor do his family members. As such, he did not have a vehicle to use during the treatment sessions.
35When considering the principles of statutory interpretation and the consumer protection nature of the Schedule, I find that the TEG supports the applicant’s position that in this case, the RSW’s vehicle would fall under the category of an “insured person’s automobile” in that it was the vehicle he had access to during the treatment sessions. Given that the applicant and his family did not have their own car, the RSW’s vehicle could be considered a vehicle that the applicant “has access to”. Alternatively, it could be considered an “other mode of transportation”. I note that the TEG contemplates a variety of authorized modes of transportation. This would include taxis, or in certain circumstances, air, rail and bus transportation services. I further note the applicant’s submissions that the use of the RSW’s vehicle and corresponding charge of $0.40 per kilometre travelled was a cost-effective option and that he had limited financial means to pay for a taxi upfront.
36In my view, the mileage costs associated with the use of an RSW’s vehicle for travel into the community during treatment sessions, falls under the category of an authorized transportation expense. The applicant has established that the denied $1,440.00 in mileage expenses, plus interest pursuant to s. 51 of the Schedule, is payable by the respondent.
Rehearing of the issue of a s. 10 award
37I have also conducted a rehearing of the applicant’s entitlement to a s. 10 award. In doing so, I have considered the parties’ evidence and submissions for the initial hearing.
38The applicant submitted that the respondent had unreasonably withheld the payment of benefits. Specifically, that from December 2021 to April 2024, it had denied a number of treatment plans, on the basis that the $65,000.00 non-catastrophic funding limit had been reached. However, over this two year period, the Standard Benefits Statements (“SBS”) confirmed that substantial amounts were still available under the policy - $31,049.52 in December 2021, $22,564.13 in June 2022, $22,339.70 in September 2022 and ongoing. These treatment plans were not reassessed until the applicant was found to be catastrophically impaired on July 8, 2024. However, the applicant submitted that even once these plans were re-assessed, the respondent still denied provider mileage and costs of paid community activities.
39The applicant also argues that the respondent refused to pay the applicant’s IRBs between July 11, 2023 until July 8, 2024, due to alleged non-compliance with attendance at s. 44 insurer’s examinations (IEs). New IEs were not rescheduled until 5 months after the alleged non-compliance, and the IRBs were not reinstated until the last IRB IE was completed. The applicant argues that the respondent should have reconsidered the suspension of IRBs once it received the applicant’s s. 25 CAT reports in August 2023, or reinstated IRBs between January and April 2024 while its own CAT IEs were underway. The applicant argues that the respondent failed to engage with new evidence or adjust its position.
40The respondent submits that it consistently adjusted the applicant’s file in good faith. It argues that once the applicant was found to be CAT by the respondent’s assessors, it reconsidered its previous denials of treatment plans. However, with respect to the previous denials, the respondent argues that it denied the treatment plans in accordance with the Schedule. Moreover, the respondent submits that the majority of the submissions the applicant made for his award claim had been decided on and resolved in the context of a previous Tribunal file.
41I find that the applicant has not established that the respondent has unreasonably withheld the payment of benefits.
42The applicant’s main argument in support of an award is that the respondent denied a number of treatment plans on the basis that the $65,000.00 non-CAT limit had been reached, when in fact, significant sums were still available in the funding limit. The applicant submits that while the respondent claimed that it had “approved” up to $65,000.00 in med/rehab benefits, it had not actually “paid” this sum. In addition to the denial letters, the applicant provided correspondence between his legal representative and the respondent’s adjuster, where the discrepancy was discussed.
43In an email dated September 27, 2022, the applicant’s legal representative requested a list of treatment plans from treatment providers with amounts that had been approved, but not yet invoiced. In emails dated March 22, 2023, the applicant’s representative noted that the respondent claimed that it had approved $22,000.00 in benefits. However, the representative stated in the email that the respondent was obliged to “take the next step” of inquiring why the $22,000.00 had not been used in over a year, and that the respondent should have investigated why the approved amounts had not been billed.
44I do not agree with the applicant that the respondent’s failure to investigate which treatment plans had been approved, but not yet incurred or billed, amounted to an unreasonable withholding of benefits. The applicant cites s. 18(3) of the Schedule which states that the “sum of medical, rehabilitation and attendant care benefits paid in respect of an insured person shall not exceed $65,000.00. He notes that s. 18(3) uses the word “paid” and not “approved”.
45While I agree with the applicant that s. 18(3) uses the word “paid” when discussing the monetary limit, the applicant does not direct me to any caselaw in support of the argument that s. 18(3) places a responsibility on insurers to investigate which approved treatment plans had been paid or billed, and inquire why they had not been billed. The applicant appears to be arguing that an insurer is obliged to keep approving treatment plans (potentially in excess of the $65,000.00 funding limit) until the billed and paid amount reaches $65,000.00. However, this could also lead to a situation where amounts well in excess of the $65,000.00 funding limit are approved and paid. The respondent had approved benefits up to the statutory limit applicable at the time. In my view, it cannot be said to have unreasonably withheld benefits when it had, in fact, approved the maximum amount of benefits available.
46The applicant argues that the respondent has the obligation to investigate the status of approved treatment plans. However, the applicant is also in a position to obtain this information, by reaching out to his treatment providers. I am not persuaded that the respondent’s failure to take the additional step of investigating the status of approved treatment plans rises to the level of conduct that was imprudent, stubborn, inflexible or unyielding or an unreasonable withholding of benefits. The respondent submitted that once the applicant was determined to be CAT, it approved invoices up to $190,000.00 within three months. Although the applicant argued that certain administrative and mileage expenses continued to be denied, these related to differing positions on what constituted authorized expenses. I do not find this to be an unreasonable withholding of benefits.
47Finally, I find that the respondent did not unreasonably withhold the payment of IRBs from July 11, 2023 until July 8, 2024. The applicant argues that the respondent should have reconsidered the suspension of IRBs once it received the applicant’s s. 25 CAT reports in August 2023, or reinstated IRBs between January and April 2024 while its own CAT IEs were underway. I do not find the fact that the respondent wanted to conduct its own post-104 week IEs to be evidence of conduct that was imprudent, stubborn, inflexible or unyielding.
48Therefore, pursuant to Rule 18.4, I am confirming the Tribunal’s decision that the applicant is not entitled to a s. 10 award.
CONCLUSION & ORDER
49The applicant’s request for reconsideration, pursuant to Rule 18.2(b), is granted.
50Pursuant to Rule 18.4, I ordered a re-hearing of the issues of the denied transportation/mileage costs, interest and an award.
51Upon re-hearing the issues, I have determined that the applicant is entitled to the denied transportation/mileage costs in the treatment plans dated December 6, 2021 and July 12, 2022, plus interest pursuant to s. 51 of the Schedule. The Tribunal’s finding that the applicant is not entitled to a s. 10 award, is confirmed.
Ulana Pahuta
Adjudicator
Tribunals Ontario – Licence Appeal Tribunal
Released: January 16, 2026